创伤激活标准越来越多对结果和资源利用的影响:一个多中心研究
Nina Y Wilson1, Harun Mazumder, Gina M Berg
1Author Affiliations: Clinical Operations Group, Center for Trauma and Acute Care Surgery Research, HCA Healthcare, Nashville, Tennessee (Ms Wilson, Dr Mazumder, Dr Garland, Ms Harbour, Dr Shen, Dr Orlando, and Dr Fakhry); Department of Trauma Services, Wesley Healthcare, Wichita, Kansas (Dr Berg); Department of Trauma Services, Mission Hospital, Asheville, North Carolina (Dr Slivinski); Department of Trauma Services, CommonSpirit Mountain Region, Lakewood, Colorado (Ms Cofran); Department of Surgery and Trauma, Atrium Health Navicent Medical Center, Macon, Georgia (Ms Johns); Department of Surgery, University of California, Irvine, California (Dr Nahmias); Massachusetts General Hospital, Harvard University, Harvard Medical School and Massachusetts General Brigham (MGB), Boston, Massachusetts (Dr Kaafarani); Department of Trauma and Acute Care Surgery; University of Colorado Health Medical Center of the Rockies, Loveland, Colorado (Dr Dunn); Department of Trauma, Rapides Regional Medical Center, Alexandria, Louisiana (Dr Moreau); Department of Trauma Services, Northeast Georgia Medical Center, Gainesville, Georgia (Ms Krause); Department of Trauma Services, Duke University Hospital; Durham, North Carolina (Ms Durst); Department of Trauma and Acute Care Surgery, University of Colorado Health Medical Center of the Rockies, Loveland, Colorado (Ms Cotner-Pouncy); Department of Trauma Services, HCA Florida Lawnwood Hospital, Ft. Pierce, Florida (Ms Mitchell); Department of Trauma Services, MedStar Washington Hospital Center, Washington, District of Columbia (Ms Kennedy); Department of Trauma, North Oaks Medical Center, Hammond, Louisiana (Ms Gennusa); and Ochsner Lafayette General Medical Center, Lafayette, Louisiana (Ms Klentzman Heard).
更多的创伤激活标准并没有改善患者的治疗结果,也没有减少选不足. 然而,标准的增加导致了更多的过度选,增加了创伤资源的负担,没有明显的临床益处.
科学领域:
- 创伤外科手术是什么
- 紧急医疗 紧急医疗
- 医疗保健管理的管理
背景情况:
- 美国外科医生协会推八个创伤激活标准.
- 许多创伤中心使用更多的标准来防止不足.
- 标准数量对分拣准确性和资源使用的影响尚不清楚.
研究的目的:
- 检查创伤激活标准数量与创伤激活率之间的关联.
- 评估标准数量与不足选,过量选,死亡率和住院时间之间的关系.
主要方法:
- 一项多中心回顾性队列研究分析了来自美国36个创伤中心 (2017-2019) 的数据.
- 使用调查和创伤登记数据来评估激活标准和患者的治疗结果.
- 多变量回归模型评估了标准数量与结果之间的关系.
主要成果:
- 创伤激活标准的平均数量为16.75 (范围:8-28).
- 标准的数量与激活率,低选率,死亡率或停留时间没有显著关联.
- 较多的标准与过度选的增加有显著的关联.
结论:
- 扩大创伤激活标准并不能改善低分辨率或临床结果.
- 更多的标准与更高的过量选有关,增加了创伤资源的负担,没有临床益处.
- 目前的做法可能会导致创伤护理的资源分配效率低下.
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